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What refugees need to know to live healthily

Living Well in Glasgow Research Report

Living Well connecting people, improving lives

Prepared by Community InfoSource

May 2014

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This research report has been supported and written by a number of

people who have each worked on different aspects of it:

Chapter One: Introduction Sheila Arthur

Chapter Two: Literature Review Duncan Sim

Chapter Three: Methodology Sheila Arthur

Chapter Four: Findings - Individuals Jamila Hassan

Chapter Five: Findings - Organisations Jane Balmforth

Chapter Six and Recommendations were written by both Duncan

Sim and Jamila Hassan

The final report was compiled by Community InfoSource

Photograph on front cover:

Final day of the very successful Mental Wellbeing Workshops

December 2013

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Contents Page

List of figures and tables 4

Acknowledgements 5

Chapter One: Introduction 6

1.1 Introduction and overview

1.2 Project development

Chapter Two: Reviews of previous literature 12

2.1 Barriers and misunderstandings

2.2 Health, happiness and “wellness”

2.3 Conclusion

Chapter Three: Methodology 24

3.1 Introduction

3.2 Methodology

Chapter Four: Research findings - individuals 30

4.1 Overview of respondents

4.2 Food habits

4.3 Access to health services

4.4 Activities

Chapter Five: Research findings - organisations 49

5.1 Aims

5.2 Findings

Chapter Six: Conclusions 60

Recommendations 62

Bibliography 63

Appendices 66

1. Living Well in Glasgow Timeline

2. Letter of introduction and individual survey

3. Letter of introduction and organisational survey

4. Details of organisations surveyed

5. Support provided by individual organisations

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List of figures and tables

Figures

Figure 1: Respondents by Region

Figure 2: Respondents by Age

Figure 3: Respondents by Residential status

Figure 4: Respondents by Length been in UK

Figure 5: Gender by Age

Figure 6: Gender by Region

Figure 7: Do you mainly cook, or buy fast food?

Figure 8: cooking skill by Gender

Figure 9: cooking skill by Region

Figure 10: do you eat the same kind of food

Figure 11: Kind of food by age

Figure 12: do you eat the same amount of food

Figure 13: Amount of food by gender

Figure 14: Amount of food by Region

Figure 15: Do you eat the same amount of fruit and vegetables

Figure 16: Do you eat different mixture of food?

Figure 17: Mixture of Different food by Gender

Figure 18: Mixture of Different food by Region

Figure 19: Are you registered with doctor

Figure 20: Are you registered with dentist

Figure 21: How has your health been compared in your home country

Figure 22: Do you think people are interested in attending workshops on

Tables

Table 1: Gender of the respondents * Cooking * Region of the

respondents

Table 3: Region * Do you eat the same kind of food?

Table 2: Gender * Do you eat the same kind of food?

Table 4: Gender * Do you eat the same amount of fruit and vegetables?

Table 5: Respondents’ Regions * Do you eat the same amount of fruit

and vegetables? Cross tabulation

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Acknowledgements

The Living Well in Glasgow Planning Group, which is now up to

meeting number 31.

The Living Well in Glasgow Steering Group, which provided support

and advice in the earlier stages of development, as have individual

members throughout.

All the Living Well in Glasgow volunteers, those who have

supported us in the past and those who still volunteer in the

administration of the project.

All the Living Well in Glasgow volunteers who took part in

developing the research, carrying out the interviews and inputting

much of the data.

Stefan Robert who, in addition, also carried out significant analysis of the

early data.

All those who took part in surveys

102 individuals and 20 representatives of organisations

All of the volunteers who helped fundraise, develop and deliver the

three types of workshops which followed from the research

Finally, the volunteer who made all of this happen, Lori Sullivan, the

Volunteer Coordinator

Our continuing thanks to them all

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Chapter One: Introduction

1.1 Introduction and overview

The dispersal of large numbers of asylum seekers to Glasgow started in

2000 and is still ongoing. These are people who have asked the UK

government, in the form of the Home Office, to give them refugee status

under the 1951 Refugee Convention and who are currently waiting to

have their applications assessed. There are currently around 3,000

asylum seekers, supported and housed by the Home Office, in the City.

In addition, over these 14 years, many have received status of some kind

which entitles them to stay in the UK, many of whom have decided to

make Glasgow their home rather than moving elsewhere in the UK.

Netto (2011) found that just over two-thirds of her interviewees reported

that they were 'very likely' to stay in Glasgow and she points to the

'connectedness to place' which many refugees felt after living in the city.

Mulvey (2013) similarly found the majority of his research participants

planning to stay in Glasgow.

Terms

Our project Living Well in Glasgow (LWiG) generally uses the term

‘refugee’ to cover all those who have come to the UK seeking refugee

status. In this report we use the word “refugee” to refer to people at

various stages of the process, namely:

British citizens from a refugee background

Those with full refugee status

Those who have indefinite leave to remain

Those who have leave to remain in the UK for a limited time

Those who are still in the formal asylum process and who are on

Home Office section 95, 98 or section 4 support

Those who have been refused asylum, are destitute and are

trying to get back into the system, while living in Glasgow

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We only differentiate between these categories where it is necessary for

a better understanding of the analysis.

Community InfoSource (CIS) has been involved with refugees and

asylum seekers (referred to as refugees from here, unless there is a

need to differentiate), through its individual directors, since 2000 (and

before). We are a group of six people, four of which come from a

refugee background and two which have worked with refugees.

Living Well in Glasgow came about through conversations between CIS

directors and different refugees about problems to do with health and

well being. Some of the issues for newcomers which are commonly

related to knowledge and information are listed below:

How do people deal with the transition of working with their

community in hard work on the land to being forbidden to work

and so having a sedentary lifestyle, probably living in a high rise

block, and being socially isolated

How do people from a hot climate learn methods of dealing with

our relatively cold weather

How do people learn what food here is nutritious and reasonably

priced and how to cook it

How do people cope with mental health issues from: the

traumas of their previous lives; their lives in the asylum system

here, and then, after receiving status, adjustment to a

completely different life in UK

Cultural differences – how do newcomers learn what behaviour

is acceptable (or not) here, especially if they are isolated

Initially a partnership was set up between CIS and Ypeople Glasgow

Residents’ Association (YGRA), an organisation with an elected

committee of people who lived in housing provided by Ypeople, the main

Home Office accommodation provider in Glasgow at that time (2011).

YGRA was particularly concerned about how to identify mental health

issues and about how to provide some kind of supportive sign- posting

for the many affected people which they could identify from their own

general experiences.

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YGRA were based in 33 Petershill Drive, in Springburn. This is where

Ypeople rented the whole building, where they had a reception desk on

the ground floor, offices on the 1st and 2nd floors, and temporary housing

where they accommodated people under the Initial Asylum Service for

their first few weeks until they were re-housed. They also provided

accommodation for some large families and some single people in

shared flats. Ypeople also provided a community space (called

Ycommunity) on the 28th floor, using the four flats. They had also

donated a room to YGRA as an office.

The research idea

Originally, the idea being developed was to set up a project which

focussed on the health and well being of newcomers to Glasgow, and in

the spirit of partnership, work alongside Ypeople (who had agreed to

support the project) and National Health Service Greater Glasgow and

Clyde’s asylum seeker base “Health Matters”, on the 1st floor of the

building at 33 Petershill Drive. Ypeople no longer has the asylum

support contract (now held by Serco) and Health Matters has now

become a different project with a change of staff, so this partnership

arrangement became inappropriate. LWiG therefore took the idea

forward independently.

After long discussion, a decision was made to develop the project for

refugees.

The aim of LWiG is to develop a pilot project for health and wellbeing

activities to address what refugees need to know to live healthily. Ideally

these could be incorporated into mainstream services in Glasgow.

The project is to be developed as a pilot one which could be rolled out to

other community groups or neighbourhoods. It was acknowledged that

every community could benefit from awareness raising on the issues we

wish to address, although we focus on ones particularly relevant for

refugees who have come to the UK to escape persecution and violence.

While developing ideas for workshops and starting to fundraise, we

realised that all of the evidence of what refugees needed to know for

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healthy living and wellbeing was anecdotal up to the present time.

Therefore we decided that the first part of the package has to be the

accumulation of evidence of what is actually needed. So we agreed to

carry out research by and for refugees, with the aim of providing the

information needed to develop activities for LWiG. What better way of

finding out than carrying out an action research project whereby refugees

developed the research methods, carry out the surveys and then analyse

the data.

Fundraising

A successful funding application was made to The Scottish Community

Foundation (now Foundation Scotland) for a grant to facilitate the

research project.

We also accessed a small grant from the European Year of the

Volunteer (through the Voluntary Action Fund) which helped us finance

the setting up of the Volunteer Project and the volunteer costs of

administering the project.

1.2 Project development

From September 2011 onwards Living Well in Glasgow recruited some

volunteers to be trained in office administration and research methods.

A Steering Group was set up, consisting of people who understand the

situation of our target group (the refugees), and had its first meeting in

October 2011. The Steering Group discussed how they could assist

Living Well in Glasgow and suggestions were made for others to join the

support structure. There were small discussion groups to gather

participants’ views on what refugees needed to know to live healthily

here, and how information should be presented to make it accessible for

them. Details from these discussions are in Methodology in Chapter

Four. The second meeting took place at the end of February 2012 and

looked at the findings of the pilot research (the first 50 surveys of

individuals) and involved helpful discussion of some of the issues

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identified (such as the use of the term GP (General Practitioner) by

professionals and the word Doctor by newcomers).

The research data was collected until April 2012 with the analysis

following. The data from both individual surveys and surveys of staff at

relevant organisations was input to Survey Monkey research package

and the results were generated in excel and pdf formats.

During Refugee Week 2012 we held a successful and professional event

which highlighted some of the results from the individual surveys. Using

some of the data based on what refugees felt they needed to know to

live healthily here, we also delivered two pilot workshops to help teach

stress management techniques, which were very highly acclaimed.

The nature of working with volunteers is that often they find themselves

having access to formal employment, no longer having the time to give to

projects, or gaining the confidence to go on to education courses, which

is as it should be.

By advertising for support, we were very pleased to find a volunteer who

helped us with the detailed analysis of the organisation interviews. The

analysis of the individual interviews took longer to find a successful

volunteer placement, with at least two false starts, but finally in 2013 we

found not only a refugee volunteer but someone who had academic

experience of analysis.

Meanwhile, in spring 2013 we advertised and interviewed for a second

group of volunteers to help develop three types of workshops. We used

the results of primary data analysis to address the highest demand

issues that refugees think they need to know to live healthily in Glasgow.

There was a lot of work involved in the development of workshops:

finding accessible locations where refugees would be comfortable to

come and could get to without too much trouble; finding accessible

premises where everyone could get in; developing the content of the

workshops; finding suitable practitioners with skills and experience of

working with refugees; taking decisions about support for childcare and

even finding a suitable source for the provision of lunch.

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Three types of workshops took place between October 2013 and

January 2014 and involved: a) Zumba classes on a Saturday, both mixed

gender and women only ones; b) a Healthy Eating & Cooking workshop

on Mondays, both mixed gender in the afternoons and women only in the

morning and c) Mental Wellbeing workshops fortnightly on Tuesday

mornings, for men and women separately.

These workshops were all very well received and there has been great

demand from participants and other professionals, that they should be

repeated for other groups.

Finally, the LWiG Planning Group is still meeting regularly (we are up to

meeting number 31) and has a committed group of six volunteers (four of

whom are from a refugee background) who are eager to move forward

with new ideas which are being developed based both on the research

findings and personal knowledge. Funding applications should be

submitted shortly.

A Timeline of the development of the project to date is attached as

Appendix One

First Steering Group meeting, 2011 Stefan and Mavis preparing for

our Refugee Week event

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Chapter Two: Review of previous literature

2.1 Barriers and Misunderstandings

There are a considerable number of reports, advice documents and

papers written about the importance of good health and lifestyle in

relation to refugees and asylum seekers.

A significant number of these are concerned with the initial arrival of

refugees and the importance of helping them to register with health

services, most importantly a General Practitioner (GP) but also with a

dentist or other health professional. The Scottish Executive (as it then

was) for example, provided advice to local authorities and other agencies

in 2004, emphasising the importance of alerting refugees to their

entitlements under the NHS, how to register with a GP, and how to

access out-of-hours services through the NHS24 helpline. Similarly, the

Scottish Refugee Council issued guidance in April 2011 on ‘How to

Access Health Care in Scotland’ and, in February 2013, a Health

Information Briefing on the health rights and entitlements of refugees and

asylum seekers in Scotland. As well as providing basic information on

registering with a GP and on, for example, out-of-hours services, the

briefings also provided information on how to obtain help with additional

healthcare costs (such as dental care, glasses, contact lenses and wigs),

and on how to make a complaint in the event of poor service by the NHS.

There have, subsequently, been a number of studies which have

explored the barriers to accessing healthcare which have been

experienced by refugees. In an important study of the health

experiences of refugees in north Glasgow, Roshan (2005) found that

there was a high level of GP registration but that refugees experienced a

number of difficulties in making use of the NHS. Principal among these

was language and communication, with many refugees requiring the use

of an interpreter. Other problems included the length of time some

refugees had to wait for appointments, uncertainties as to their rights and

entitlements, difficulties in travelling to surgeries and health centres, and

interactions with NHS staff – sometimes because staff themselves were

unsure how to deal with refugee patients.

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In another Glasgow study, O’Donnell et al (2007) noted in relation to

language barriers that there is sometimes a tension between interpreters

translating verbatim and acting as patient advocates. Additionally,

access to interpreters in other settings, for example in-patient hospital

stays could be problematic. They also found that refugee families with

limited resources sometimes found it hard to afford over-the-counter

medication such as children’s paracetamol.

Barriers to health care are particularly significant in the case of older

refugees whose knowledge of English may be poorer and who may be

less able to articulate their needs. Yet they may be experiencing ageing

faster, possibly due to traumatic experiences and many refugee women

require health support during the menopause. Older refugees may be

particularly affected by isolation because of the stereotype that BME

communities ‘look after their own’ and therefore that care support is not

needed (Connelly et al 2006).

Indeed, there has often been a marked variation in the ability of different

parts of the NHS in responding to cultural diversity. In areas with long-

established black and minority ethnic communities, health services have

experience of meeting the needs of people with different religious,

language or cultural backgrounds (Johnson 2006). But perhaps in

Scotland, with a much smaller BME population prior to the late 1990s,

this was not necessarily the case. Nevertheless, the Race Relations

(Amendment) Act 2000 has laid a statutory duty on the NHS and other

public bodies to develop race equality strategies and to ensure equal

treatment of all users.

Szczepura (2005) therefore argues that providing appropriate access to

health care for a diverse population is about more than simply providing

the service. She draws attention to the need for services not just to

demonstrate linguistic competence (in terms of interpreting and

translation services) but also cultural competence. Cultural dimensions

of health might include:

Patients’ health, healing and wellness belief systems

How illness, disease and their causes are perceived

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The behaviour of patients seeking health care and their attitudes

towards healthcare providers

The views and values of those delivering health care

At the end of the day, as Szczepura points out, the aim is for BME

service users to have equal access to and appropriate information about

the NHS, to have appropriate and sensitive services, and to be able to

use the NHS with ease.

The extent to which users actually feel at ease depends not just on

removing barriers to access but also in improving knowledge of how the

NHS actually functions on a day-to-day basis. Those refugees who have

come from countries without a well-developed system of primary

healthcare, for example, may expect a hospital referral for conditions that

in the UK would be treated by a GP or Practice Nurse (Burnett and Peel

2001). There have therefore been various misunderstandings, where

refugees have used Accident and Emergency services inappropriately,

either for routine health problems (Ager and Strang 2008) or during the

night because of a lack of knowledge of out-of-hours services (Mulvey

2013).

Research by Wasp et al (2004) suggests that heads of households have

a generally better understanding of the workings of the NHS, as do

young refugees, who tend in any case to be healthier and to make less

use of health services. Wasp et al also draw attention to the fact that

many refugees do not understand the treatments administered due to a

lack of explanation compounded by language differences. By way of

example, Papadopoulos et al’s (2004) study of Ethiopian refugees notes

how traditional remedies are more likely to be used in Ethiopia and so

there was a lack of understanding of the treatments prescribed by the

NHS.

Health Promotion

As part of the process of removing barriers to health care, it is widely

recognised that health authorities can do much actively to promote good

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health and to ensure refugees are made aware of the availability of

services.

A number of cities, for example, have outreach teams who target recent

refugee arrivals. In London, for example, Kensington, Chelsea and

Westminster’s Equal Access to Health Care Project use community

health workers to work with new arrivals, while Lambeth, Southwark and

Lewisham have a special outreach team with a specific focus on single

homeless BME people, many of them refugees (Refugee Health

Consortium 1998). Health visitors do similar work in the West Midlands,

while in Nottingham, there is a community-based asylum seeker and

refugee health outreach team to provide health promotion and to build

knowledge and capacity in mainstream services (Bunting 2009).

There are similar approaches in other countries. In the Australian state of

Victoria, a Refugee Health and Wellbeing Action Plan seeks to work with

refugees to promote improvements in refugee health, sometimes through

promoting access to services and sometimes through improved diet

(Victorian Refugee Health Network 2008). New Zealand has established

a Refugee Health and Wellbeing Project to promote healthy living and

has had considerable success. After a 10-month health education

programme, they reported significant increases in awareness of the

importance of cancer screening, of the symptoms of meningitis and the

availability of immunisation for communicable diseases. There was also

a significant drop in the number of people who said they smoked (New

Zealand Red Cross 2013).

The process of promoting good health amongst refugees has been

portrayed as a ‘journey to wellness’ by Palinkas et al (2003). In an

important study, they draw attention to the ‘health burden’ with which

refugees arrive, including trauma and stress-related disorders,

depression, substance abuse, infectious and parasitic diseases and an

increased susceptibility to chronic diseases. The journey to wellness

therefore focuses on treatment of psychiatric disorders and of infectious

diseases, and prevention of chronic diseases. Working in San Diego,

California, the consortium working with refugees has implemented a

number of health promotion programmes and developed a range of

educational materials aimed at improving knowledge of treatments for

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cancer, diabetes and cardiovascular diseases. They portray this as a

‘two-way process affecting both the migrant and the organisations

dedicated to helping the migrant on the journey to wellness’.

2.2 Health, happiness and ‘wellness’

This concept of ‘wellness’ or wellbeing as a journey leads us to consider

the importance of wellbeing as a key part of living in the wider society.

Johnson (2006), for example, argues that good health enables better

participation in society and the supply of appropriate health care shows

the responsiveness of society to the needs of new members. Indeed,

although health is not always cited as a core factor in integration,

fieldwork by Ager and Strang (2008) suggests that good health was

widely seen as an important resource for active engagement in a new

society. So good health and wellbeing are key to long-term integration

by the new refugee communities.

In clarifying what is meant by integration, Johnson (2006: 57) suggests

that the key factors must be:

Equity of access to relevant health services;

The ability of health and social care services to respond to the

specific needs of the relevant minority groups; and in the long-term

A parity of health outcomes and life expectancy or disease

experience.

Parity of outcomes can be achieved not necessarily through refugees

adopting the lifestyle choices of the host population – which may not

always be healthy ones! Rather, the long-term aim should be to ensure

that there are no statistical differences between the health of the host

and refugee communities.

Health and wellbeing are closely linked in many of the studies of refugee

health. Wasp et al (2004) interviewed a number of refugees who found

that the simple act of talking to others helped to relieve stress and had a

positive effect on health. Papadopoulos et al’s (2004) study of Ethiopian

refugees identified six ‘meanings’ of health, namely:

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Happiness

The ability to fulfil material needs and ambitions

Harmonious relationships

Positive personal qualities and attributes

Physical, mental and spiritual wellbeing

A healthy environment.

For the Ethiopians, ‘desta’ or happiness was the most important

prerequisite and indication of health.

Finally, Lewis (2009) identifies the centrality of food to the long-term

happiness and wellbeing of refugees. She identifies the importance of

food to refugees’ sense of community and the lengths to which some

refugees will go to obtain traditional produce. The emotional value of

food lies in a link to specific places and times that people have left

behind. Western diets may be unappealing to many refugees and are

not always healthy; therefore a focus on traditional eating and cooking

practices may assist with long-term health and wellbeing,

We move on now therefore to consider the wider aspects of diet, nutrition

and the links to health.

Nutrition and diet

Deficiencies in diet and nutrition are common amongst refugees and

asylum seekers. Pre-arrival factors which will affect nutrition include

prolonged deprivation, malnutrition, drinking contaminated water,

untreated or undiagnosed illnesses such as parasitic infections and

chronic diarrhoea, and dental problems which cause difficulties when

eating (Victorian State Government 2012).

However, once settled in a safe country, refugees continue to face

nutritional challenges and research suggests that they often become

accustomed to poor eating habits. Two American studies (Barnes and

Almasy 2005, Rondinelli et al 2011) show how refugees became

accustomed to an American lifestyle, including consumption of high-

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calorie, nutrient-poor foods and this was a particular problem amongst

children who were targeted by the fast food industry. In Barnes and

Almasy’s study, only 13% of refugees thought they ate healthily,

acknowledging that they ate too many calories, too many sweets and too

much fat. Closer to home, an Irish study (Manandhar et al 2006)

identified a similar problem, with refugees eating too much protein and

saturated fats and fewer carbohydrates. Although the intake of fruit and

vegetables was adequate, it was perceived to be low by the refugees

compared to their previous diets.

Although refugees recognised the fact that their eating habits were often

poor, there were considerable barriers to eating better. These included

the high cost of some fresh fruits and vegetables, the general cost of

food in many western countries, the limited amount of time available to

prepare food when adults had to work outside the home and the

cheapness and easy availability of fast food (Barnes and Almasy 2005).

Manandhar et al (2006) suggest that many parts of Ireland are ‘food

deserts’ for refugees, especially when they are accommodated in

peripheral housing with limited access to shops stocking preferred

‘ethnic’ foods and affordable healthy food options. This scenario would

also apply to many parts of the UK.

Southcombe (2008), writing about refugees in Australia, defines the

problem as ‘food insecurity’ which exists ‘whenever the availability of

nutritionally adequate and safe foods or the ability to acquire acceptable

foods in socially acceptable ways is limited or uncertain’. She notes the

high prevalence of food insecurity among refugees resettled in

developed countries, associated with poor dietary practices, overweight

and morbidity and she refers to various local Australian studies

identifying a prevalence of food insecurity among refugees of over 70%.

The impacts of food insecurity and poor nutrition are significant. In

Barnes and Almasy’s (2005) study, 52% of refugees believed that they

were overweight and 74% believed that they were less active than they

should be to be healthy. 61% thought that they were less active since

arriving in the United States, a key factor being an increased use of cars.

There was a negative impact on oral health and vitamin deficiency and,

in terms of disease, Rondinelli et al (2011) found that rates of diseases

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that are commonly nutritionally influenced (such as diabetes, heart

disease and high blood pressure) were increasing linearly with the length

of time that refugees were living in the US. Poor diet was also impacting

negatively on breastfeeding by reducing women’s ability to eat and feed

on demand, and refugees were increasingly using processed feeding

products. Indeed, Sellen and Tedstone (2000) refer specifically to the

nutritional risks posed to children because of refugee poverty and the

difficulties of adapting eating and child feeding practices to new social,

cultural and economic conditions. They suggest, however, that we have

insufficient knowledge of these risks and call for more research.

There is therefore a growing recognition of the need to work with

refugees to help them identify appropriate and healthy diets. In America,

for example, the US Committee for Refugees and Immigrants has

developed a Nutrition Outreach Toolkit and a range of educational

materials for those working with the refugee communities1, while in

Australia, the government developed the Fairfield Refugee Nutrition

Project2 and, in Perth, the ‘Good Food for New Arrivals’ training

resource3. These resources comprise a variety of materials, including

advice to community workers and presentations and activities for using

with refugees themselves.

The challenge in seeking to tackle the problem of poor nutrition in

refugees is to change behaviour (Barnes and Amasy 2005). The easy

availability and relative cheapness of fast food is clearly attractive.

Research shows that refugees from many countries have a knowledge of

healthy food choices, physical activity needs and the risks associated, for

example with smoking. But knowledge does not always translate directly

into healthy behaviours.

1 http://www.refugees.org/resources/for-refugees--immigrants/health/healthy-living-toolkit/ 2 http://www.aifs.gov.au/cafca/ppp/profiles/cfc_fairfield_nutrition.html 3 http://nutrition.asetts.org.au/

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Specific health needs

So far, we have discussed the health and nutritional needs of refugees

as a whole, but it is clear that, within the overall refugee population,

specific health needs have emerged and have often been the subject of

specific studies.

Mental health

Mental health is a significant issue for refugees and asylum seekers, with

the trauma of migration leading to depression, stress, sleeplessness and

anxiety. Social isolation and poverty in their new country can have a

compounding effect on mental health. In a Cardiff study (Cardiff Health

Alliance 2011), for example, a third of refugees were receiving medical

treatment, most notably treatment for depression in the form of anti-

depressants and / or counselling. We need to recognise, however, that

refugees more often need social care than psychiatric treatment and so a

standard medical model of care may not necessarily be appropriate

(Simich et al 2010).

What is particularly significant in relation to mental health problems is

their persistence. Mulvey’s (2013) study in Glasgow uses a ‘Warwick

Edinburgh Mental Well Being Scale (WEMWBS) to measure problems.

He found that, despite refugees accessing employment, being in more

secure housing, securing status and often bringing family to Scotland,

nevertheless WEMWBS scores actually rose over time. This appeared

to be a hangover effect resulting partly from the trauma of migration and

partly from the asylum process, so mental health problems were

ongoing. Mulvey also noted significant under-reporting by refugees.

Women

Research suggests that women may have an insufficient voice in

articulating their health problems and needs. Partly this may be a result

of their being isolated at home in a childcare role, partly it may reflect

(perhaps as a result) a poorer knowledge of English, and partly it may

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reflect the fact that they may be from a patriarchal society, where

women’s voices are not well heard.

Some women may be reluctant to consult with a GP (particularly a male)

if rape or sexual abuse has occurred. And there appears to be a low

uptake of health promotion programmes, for example prevention

measures amongst refugee women, in relation to cancer screening

(Refugee Health Consortium 1998).

We have already referred to reduced breastfeeding rates, often caused

by poor nutrition. McCarthy and Haith-Cooper (2013) also refer to the

insufficient use made of maternity services by refugee women and their

complex care needs, which midwives have to meet. They find that

befriending schemes have had an impact in helping to remedy the

position.

Older people

We have referred earlier to the particular difficulties facing older people

in accessing health services, including poorer language skills, isolation

and a belief that minority ethnic families ‘look after their own’ elders. But

older people often need additional health support, linked to the process

of ageing, possible disabilities and frailty. Carers too may need support,

something that is increasingly recognised.

Older people may be financially disadvantaged and may struggle to

understand pension provision and this may affect their ability to access

support (Connelly et al 2006).

Children and young people

Children and young people may be particularly affected by the trauma of

migration, if they are unsure what is happening to them and such trauma

may lead to drug or alcohol abuse. Adolescence is in any case, a time of

transition from childhood to adulthood and a period often associated with

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mental disorders and behavioural difficulties. For young refugees, it can

clearly be a particularly complex process (Milosevic 2002).

Where young people attend school, their language skills will improve

markedly and they may find themselves as the main interpreter or

advocate for their family’s health needs. They therefore take on a

responsibility unmatched to their age and this can be somewhat

traumatic in itself.

Schools need to be alert to health issues affecting refugee children and

adolescents and have an important role to play, for example, in

promoting immunisation in young people (Refugee Health Consortium

1998)

2.3 Conclusion

The literature clearly demonstrates a situation where refugees need

substantial support and advice in relation to health and wellbeing,

including a healthy lifestyle. The initial arrival of refugees prompts a

focus on GP registration and access to health services but longer-term

settlement means that the focus of support needs to shift towards the

promotion of good health, good diet and good nutrition, while recognising

that certain groups within the refugee population need particularly

intensive support.

Some researchers have stressed the value of befriending schemes,

particularly for women who may experience isolation and who may

require advice and support in relation to issues such as childcare and

breastfeeding (McCarthy and Haith-Cooper 2013). Counselling services

are also valuable in relation to mental health and other sensitive issues.

The concept may be unfamiliar to many refugees but it can be helpful if it

is culturally sensitive to the needs of ethnic minorities; indeed there is a

strong case for refugee communities to develop their own counselling

skills (Burnett and Peel 2001).

Finally, there are various ways in which the wellbeing of refugees can be

supported. We have already referred to nutritional advice but other

23

approaches can be highly successful. In Manchester, the Refugee

Wellbeing Project4 delivered a wide range of activities including gym

sessions, cycling, self-defence, laughter workshops, trips around the city,

multi-sports sessions and cookery contests. As well as the group

sessions, practical help and health advocacy was provided and the

project appears to have been highly successful.

Ready to leave after another invigorating Zumba class,

November 2013, Vivace Theatre School in Sauchiehall Street

4 http://www.groundwork.org.uk/Sites/targetwellbeing/pages/refugee-well-being-project-tw

24

Chapter Three: Methodology

3.1 Introduction

The information for this study was gathered in a variety of different ways,

including background information on refugees, obtained from ‘desk top’

research, a survey of 100 refugees, using a questionnaire and interviews

with key professionals involved in the refugee process in Glasgow,

including staff in the Scottish Refugee Council, British Red Cross and

Freedom from Torture.

The main driver for the type of methodology using “action research” was

the principle of using researchers from the group of people being

interviewed to develop and carry out the research. Therefore we aimed

to recruit around 80% of the research planners, interviewers and

analysts from refugee backgrounds. The inclusion of 20% from a local

background was expected to aid integration and could provide additional

local knowledge for the group.

Accordingly therefore, the interviews with individual refugees and

organisations were also conducted by refugees. This approach has

been shown to have a number of advantages (Mestheneos 2006).

Participation in the research can be a valuable professional experience,

enhancing skills and boosting self-esteem. In addition, there is

satisfaction in working on a project which has the ability to influence

policy and practice and to benefit others. We also found that refugee

researchers have a clearer understanding of the issues facing other

refugees.

This ‘peer research’ approach, in which individuals are interviewed by

their ‘peers’, has been used successfully in other studies. Within

Glasgow, Roshan (2005) assessed the health needs of refugees and

asylum seekers in north Glasgow using peer researchers, suggesting

that they gained both professionally and personally from their

involvement in the work. In London, Dumper’s (2002) skills audit of

refugee women for the Mayor of London’s office used other refugee

women to carry out the interviews. Dumper suggests that barriers

arising out of a mistrust of strangers and people in authority were

25

overcome, and the exercise helped to empower those refugee women

who became involved.

Identifying potential research and administration volunteers

Potential researchers were identified through advertising widely and by

the provision of information about the benefits of volunteering in such a

project. Organisations which had contact with refugee communities were

provided with the advertising (emails, flyers and posters) and it was also

sent to individual refugees who were contacts of our organisations. As

the project was developed and managed by people who were either

refugees or who worked with refugees, there was significant word of

mouth advertising as well.

At the same time, Living Well in Glasgow was also advertising for

administrative volunteers. The development of the whole project was

being taken forward by volunteers, from the Volunteer Coordinator to the

Planning Group. The administration of the project was also supported by

volunteers who had learnt office skills or practised them in college but

had not had the opportunity to use them in a professional setting.

Potential researchers were asked to complete an application form and

were then to come for a discussion with the Team. These meetings took

place in the Ycommunity space on the 28th floor of 33 Petershill Drive,

which is a building which still houses induction stage asylum seekers

during their first weeks in Glasgow, and some asylum seekers. The

Residents’ Association had been provided with office space on there,

which was used for the interviews.

The applicants had already been asked to decide whether they wanted

to volunteer on the research or the administration parts of the project.

The work involved and the commitment being made by both the

volunteer and the project team was discussed by a person from a

refugee background from the Planning Group plus the Volunteer

Coordinator. By October 2011 we had recruited a starting group of 4

administration and 6 research volunteers.

26

The whole Living Well in Glasgow volunteer project started with an

induction into the organisations involved in the project and with

information about what Living Well in Glasgow was hoping to be able to

do as a result of the research. There was also a discussion opportunity

for the new volunteers to contribute their thoughts.

3.2 Methodology

Aim of the study

This study is a baseline study with the aim of providing information

needed to develop activities for the Living Well in Glasgow (LWiG)

project. The aim of LWiG is to develop pilot health and wellbeing

activities to address what refugees need to know to live healthily here

and which could ideally be incorporated into mainstream services in

Glasgow.

Training research volunteers

In total, ten research volunteers were recruited during the research

period. Seven were female and three male. The research volunteers

came from Algeria, Cameroon, England, Kurdistan (Iraq, Kurdish Sorani

speaker), Scotland/France, Sierra Leone, Sudan and Zimbabwe. The

range of countries of origin meant that we were able to use a wide range

of languages during the interviewing process.

Each researcher was asked to commit to volunteering until the interviews

were completed and the data uploaded for analysis, as a minimum

(unless they had a change of circumstance).

Following recruitment, training was provided by Community InfoSource.

The training focused on types of survey development, interviewing skills,

cultural and ethical issues, methods of recording interviews and analysis,

dissemination and, where necessary, IT skills.

27

The training also sought to provide support in terms of confidence

building for the interviewers, in order to enable them to carry out the

survey. In addition, support was put in place in case the interviews

raised difficult issues for the interviewers and/or interviewees.

Developing the research methods and analysis

Following the training, the research group started development of the

research plan. They met twice a week to do this. It was agreed that the

main research would focus on the views of individual refugees and

additional information would be requested from organisations or

individuals who worked closely with refugees.

The research method used for both individual and organisational surveys

was individual interviews where a questionnaire with mostly closed-

ended questions was used (Appendix Two and Three).

Both the individual and organisational surveys were developed by the

volunteer researchers who were mainly refugees, plus one or two people

living in Glasgow who had close contact with the refugee communities.

Each interview was expected to last about 30 minutes, but could take

longer if an interpreter had to be used. The interviews mainly took place

in local community facilities where the interviewee and interviewer felt

comfortable, although some took place at other locations to suit the

interviewee.

The volunteers who carried out the primary analysis used Survey

Monkey software for this initially.

After consideration, it was decided to use Survey Monkey to produce a

basic analysis of the information collected in the individual survey

interviews. Two of the volunteers taught themselves how to use this

format and set up the survey based on questions the group decided were

appropriate. After piloting this, a hard copy was then used in the actual

interviews. The resulting data from the interviews was then input to

Survey Monkey and the completed survey forms returned to the office.

28

Unfortunately the volunteer who started the analysis had to leave before

the report was done. As a result the work stopped for a while until a new

volunteer resumed it.

The new volunteer decided to use SPSS statistics software, and she

trained a volunteer to help her with data entry, after which the analysis

was developed.

The interview process and sample

Individuals

Prior to the interviews, a request letter with basic information about the

project, its aims and objectives, contact details for the team, and how the

results would be used was given to the expected respondents. This letter

emphasised the confidential nature of the process. (see Appendix Two).

This letter was translated into several languages including Arabic and

French.

To overcome the language barrier we used an interviewee’s mother

tongue whenever it was possible, otherwise we used interpreters.

The sampling method was opportunistic whereby we accessed

interviewees wherever we came across them, although we tried to cover,

as far as possible, a range of different countries, different lengths of time

living in the UK, different age groups, as well as achieving a gender

balance. The sample size was 50 for the pilot study. A further 52 took

part in the final study. As little change was made to the questionnaire

after the pilot research, it was decided to amalgamate the two samples.

However, two questionnaires were excluded from the analysis due to

incomplete data leaving a total of 100 respondents.

Organisations

A list of suitable organisations and individuals who were known to work

with refugees and be sympathetic to their needs was drawn up by the

research volunteers. It was agreed that this list should be limited to 20

29

organisations in order to be manageable. The survey form which was

developed was much shorter than the one for individuals and was

intended to gather organisational information, details of any services

which were provided and the views of the individual taking part on what

was needed to help refugees live healthily here.

The Steering Group were asked the basic questions below in a workshop

at their first meeting (before the formal interviews took place). Their

answers are amalgamated.

A- From your experience, what do you think asylum seekers and refugees need to know to live healthily in Glasgow? A number of responses were received, with the main ones being:

How to access cheap/healthy food (fruit and vegetables etc)

Correct signposting: language needs, where to get own country food

What GP offers & other health services they are entitled to

Mentoring, befriending, preventing isolation

Accessible information on health, housing, education, lawyers, sport,

budgeting and travel

B- How can information be presented to people whose first language is not English? Responses included:

Forming Languages groups

Have multi-lingual audio/video resources & provide information in all

useful formats

Use social media/Facebook etc

Combination of different choices: DVDs, leaflets in all languages,

translators.

Using images rather than words but make sure to get the basic signs

translated with the help of volunteer translators/interpreters

30

Chapter Four: Individual survey results

This section covers the core part of the report: data analysis and

findings. It is divided into four main parts: the first one describes the

statistics of the target group, the second is an exploration of their food

habits, the third part is on access to health services, and the last is on a

subjective estimation of the gaps of knowledge among the target group.

4.1 Overview of respondents

The sample used in this study was composed of 100 refugees and

asylum seekers, 40 of them females. They were of different cultural

backgrounds, ages and residential status as well as length of time living

in the UK. These factors will be considered in turn.

4.1.1 Cultural background

Knowing the cultural background is important to explain barriers that face

integration of newcomers in their host society and access to public

resources, as well as indicating needs for each group that might help

policy makers to target specific group(s). Cultural background, here, is

indicated by the country of origin of the respondent. Respondents were

originally from 30 different countries. However, for simplicity and

research ethic they are divided into three groups based on geography

and cultural similarity: Middle East and North Africa (MENA)5, Africa6, and

East and South Asia (Asians).

All of the respondents answered the question about their country of

origin. As Figure (1) shows, most of the respondents are from Africa

(49%) and MENA (46%), while only a few of them (5%) are from East

and South Asia. Though the sample is random, this is not a surprising

5 The term covers an extensive region, extending from Morocco to Iran, including the majority of both the

Middle Eastern and Maghreb countries. The term is roughly synonymous with the term the Greater Middle

East. (http://en.wikipedia.org/wiki/MENA)

6 Africa is the rest of African countries that are not included in MENA

31

Africa 49%

MENA 46%

South & East Asia

5%

result, since Africa and the Middle East have been suffering from

protracted political instability and economic crisis for decades.

Figure (1): Respondents by Region

4.1.2 Age

The ages of the respondents might reveal barriers that face specific age groups, and help in accurately addressing such barriers. As mentioned above, for example, old people have different barriers in accessing health services, and young ones have different health needs. 98 per cent of the respondents stated their ages. The age of the respondents is grouped into five categories. Though the sample was random, as mentioned above, we tried to cover different age groups as shown in Figure (2). The sample is dominated by those between 25 and 34 years old (51%), followed by those between 35 and 59 years old (23%), and the group between 18 and 24 (19%), while four percent are under 18 and two percent are seniors. Under-representation of those under 18 and senior people in the sample could be explained by restricted mobility of these categories.

32

Refugee 27%

Asylum seeker 62%

Asylum seeker in section 4 support

4%

Asylum seeker on no

support 8%

Figure (2): Respondents by Age

4.1.3 Residential Status

The residential status of the respondents varies between refugees, asylum seekers, asylum seekers in section 4 support and asylum seekers without support. The question about the residential status was added to the questionnaire after the pilot study, and as a result 48 respondents were not included. As Figure (3) shows 62% of the sample consists of asylum seekers, 27% are refugees, 8% are refused asylum seekers and destitute, and 4% are asylum seekers on section 4 support.

Figure (3): Respondents by Residential Status

Under 18 4%

18-24 19%

25-34 52%

35-59 23%

60+ 2%

33

4.1 4 Length of time living in the UK

The period immigrants live in host countries is positively correlated with

immigrants’ integration. Therefore, we asked about the length of time

each respondent has stayed in the UK. Two of the respondents did not

answer this question.

The period of time respondents lived in the UK, in this study, was divided

into three categories: ‘less than one year’, ‘less than three years’, and

‘three years and more’. Most of the respondents (54%) are newcomers;

having lived less than a year in the UK, while fourteen percent have lived

for less than three years, and the rest have been living in the UK for

three years or more (Figure 4).

Figure (4): Respondents by length of time in UK

4.1.5 Gender

As mentioned above 40 percent of the sample are female. Gender,

however, is an essential factor in the analysis; therefore we will break it

down by age and cultural background. The dominant age category of

both genders is between 25 and 34, followed by the older category

among the females, and the younger among the males (see Figure 6).

Considering the cultural background, while most of the women are from

Africa, most of the male are from MENA (see Figure 5).

Less than one year

54%

Less than 3 years

14%

3 years or more 32%

34

4.2 Food habits

Five questions were addressed to the respondents in order to assess

their cooking skills, changes in their food habits and in their food intake

both in quantity and quality. Additional questions were posed in order to

find the reasons behind the changes (if any). In this section we analyse

these questions broken down by some of the respondents’

characteristics introduced in the previous section.

4.2.1 Cooking skills and access to nutritious food

Cooking is an essential daily activity for both genders in Northern

countries, yet the situation might not be the same in the Southern

countries. This skill is essential for accessing nutritious food, rather than

buying fast food. Therefore, assessing newcomers’ cooking skills

reveals whether it is necessary to help them with developing such skills.

To assess their cooking skill respondents were asked whether they

mainly cook by themselves, bought fast food or used a mixture of both

methods. Twelve percent of the respondents were found to depend

totally on fast food, while sixteen percent used a mixture of both (Figure

7). This indicates that around 28% of the respondents need to develop

their cooking skills, or to be helped to raise awareness of the importance

of healthy food. Though no direct question was posed about the need

0

20

40

60

80

100

Female Male

Figure (5): Gender by Region

Africa MENA Asia

0

10

20

30

40

50

60

70

80

90

Under 18

18-24 25-34 35-59 60+

Figure (6): Gender by Age

Female Male

35

for developing cooking skills, this result does not imply that the rest have

no need to develop these skills,

Figure (7): Do you mainly cook, or buy fast food

The sample reflects the gender division of labour in the South, where

mostly cooking is females’ responsibility. As Figure (8) shows, 84% of

females cook their own food, while only 60% of males do so.

Considering cultural background, Figure (9) shows that all south-Asians

mainly cook their food, while Africans cook more than the MENA people.

This could be explained by gender division of labour, where in the culture

of most MENA countries cooking is a females’ role. Our sample

supports this argument, as table (1) shows none of the MENA women

depends on fast food, while a fifth of the men do.

72%

12% 16%

Mainly cook Mainly buy fast food Both

36

Figure (8): Cooking Skill by Gender Figure (9): Cooking Skill by Region

------------------------------------------------------------------------------------------------ Table 1: Gender and Region in relation to Cooking Skills

Region of the respondents

Do you mainly cook or buy fast

foods?

Total Mainly cook

Buy fast

food Both

Africa Female 88% (28) 3% (1) 9% (3) 100% (32)

Male 69% (11) 19% (3) 12% (2) 100% (16)

Total 81% (39) 8% (4) 11% (5) 100% (48)

MENA Female 80% (4) 0% (0) 20% (1) 100% (5)

Male 56% (23) 20% (8)

24%

(10) 100% (41)

Total 59% (27) 17% (8)

24%

(11) 100% (46)

South & East

Asia

Female 100% (3) 0% (0) 0% (0) 100% (3)

Male 100% (3) 0% (0) 0% (0) 100% (3)

Total 100% (6) 0% (0) 0% (0) 100% (6)

0

20

40

60

80

100

Female Male

Mainly cook Maily buy fast food Both

0

20

40

60

80

100

120

Africa MENA Asians

Mainly cook

Mainly buy fast food/ take-away

Both

37

To sum up, at least 29% of the respondents need to develop their

cooking skills and have their awareness of the importance of healthy

food raised. The group that need this most are the men from MENA.

4.2.2 Kind of food

In the previous section around one third of the sample were shown to

have poor cooking skills, which raises the question “Has this effect been

due to the kind and amount of food they were used to in their home

countries?” The second question addressed to the respondents was

about whether they eat the same type of food they used to eat in their

home country. 99 percent answered this question, and 45 percent of

them gave an affirmative response. This result indicates that the

majority of the respondents have experienced changes in the kind of

food they were accustomed to. Considering the gender factor, we found

slight difference where males (56%) were more likely to have changed

their food kinds than females (53%). (See Table 2).

Considering the region, more Asians (67%) have not changed their kind

of food, where the opposite is true in the case of the other groups

(around 44% for each). This result indicates cultural similarity between

Scottish and Asian people in term of food habits, while indicating a wider

cultural distance between the host and the other two groups.

Figure (10): Do you eat the same kind of food?

-----------------------------------------------------------------------------------------------

Yes 45%

No 55%

38

Table 2: By Gender * Do you eat the same kind of food?

---------------------------------------------------------------------------------------------------------------- Table 3: By Region * Do you eat the same kind of food?

The majority of the respondents have experienced changes from the kind of food they were accustomed to; males being more adaptive to the new food than females.

Do you eat the same kind of food

Yes No Total

Female 47.5% (19)

52.5% (21)

100.0% (40)

Male 44.1% (26)

55.9% (33)

100.0% (59)

Total 45.5% (45) 54.5% (54) 100.0% (99)

Do you eat the same kind of

food?

Total Yes No

Africa 43.8% (21)

56.2% (27)

100.0% (48)

MENA 44.4%(20)

55.6% (25

100.0% (45)

South & East Asia

66.7% (4) 33.3% (2) 100.0% (6)

Total 45.5% (45)

54.5% (54)

100.0% (99)

39

Figure (11): Kind of Food by Age Figure (12): Amount of food eaten

Considering the age of the respondents, the group that experienced most change in the kind of food they ate were those between 18 and 24 years old. This might be explained by poor cooking skills, or easy adaptation to the new culture. 4.2.3 Do you eat the same amount of food?

Regarding the amount of food, a considerable number of the participants (41%), took almost the same amount of food, while 35 percent took less amount and 24 percent took more. Figure (13): Amount of Food by Gender Figure (14): Amount of Food by Region

More 38%

About the

same 38%

Less 24%

0

5

10

15

20

25

30

35

40

45

50

Female Male

More About the same Less

0

10

20

30

40

50

60

Africa MENA South & East Asia

More About the same Less

0

20

40

60

80

100

120

Under 18

18 - 24 25 - 34 35- 59 60 +

Yes No

40

While most of the women eat more food than they used to before coming

to the UK, most of the men eat less food. This difference might be

related to the cooking skills mentioned above.

Most of the Africans and Asians said they eat about the same amount,

while most participants from MENA countries eat less food.

4.2.4 Do you eat the same amount of fruit and vegetables?

67 respondents answered the question about fruit and vegetable

consumption. 45 percent of them consume the same amount as they

used to in their country of origin, 30 percent consume more, while 25

percent consume less.

Figure (15): Do you eat the same amount of fruit and vegetables?

Most of the females either consume the same amount of fruit and vegetables that they used to (50%), or more (37%); while 41 percent of the males consume the same amount, 24 percent more, and 35 percent less.

Table 4: By Gender * Do you eat the same amount of fruit and vegetables?

More 30%

About the

same 45%

Less 25%

Do you eat the same amount of fruit and

vegetables?

Total

More About the same Less

Female 37% (11) 50% (15) 13% (4) 100% (30)

Male 24% (9) 41% (15) 35% (13) 100% (37)

Total 30% (20) 45% (30) 25% (17) 100% (67)

41

Table 5: Respondents’ Regions * Do you eat the same amount of fruit and vegetables? Cross tabulation

Considering the regions of the participants, 75 percent of Asians, and 50

percent of MENA said they consume the same amount of fruit and

vegetables as before, while only 39 percent of the Africans did. None of

the Asians consumed more, while 41 percent of the Africans and 19

percent of the MENA did. Respondents from MENA are dominant

among those who consume less (31%), followed by the Asians (25%),

and then the Africans (22%).

Numerous contradictory reasons are cited for changing habit of fruit and

vegetables consumption. The most frequent cited reasons for those who

consume more are: Affordable, available, cheaper, back home eat only

rice or not eating it, I like it, I think it is good for health.

Those who consumed less fruit and vegetables than before explained it

as a financial problem (affordability). Other reasons given are: Don’t like

it, back home I eat fresh fruit, no appetite, expensive, financial reasons,

not affordable, I don’t value it, not used to it.

4.2.5 Do you eat the same mixture of different foods?

Earlier we explored whether respondents ate the same kind and amount

of food, and fruit and vegetables they used to consume before moving to

the UK. In this section we are going to study whether they change the

mixture of fruit and vegetables they used to eat in their home countries.

Do you eat the same amount of fruit and

vegetables?

Total

More About the same Less

Africa 40.5% (15) 37.8% (14) 21.6% (8) 100.0% (37)

MENA 19.2% (5) 50.0% (13) 30.8% (8) 100.0% (26)

South & East Asia 0% (0) 75.0% (3) 25.0% (1) 100.0%(4)

Total 29.9%(20) 44.8% (30) 25.4% (17) 100.0%(67)

42

The answer to this question highlights whether people’s diets had

changed significantly since their arrival and whether they were accessing

a diverse range of different foodstuffs. The overall result (Figure 16),

shows that 24 percent of the respondents said they consume ‘less

mixture’ of different kinds of food, while the rest of the sample divided

equally between ‘same’ and ‘more’ mixture.

Figure (16): Do you eat a different mixture of foods?

As shown in Figure (17), more females (56%) said they consume ‘more’

mixture of different kinds of food than they were used to in their home

countries, compared to males (27%). In contrast, more males (31%)

said they consume ‘less’ mixture of food than what they were used to in

their home countries compare to women (12%). This indicates that men

and women have slightly different approaches to eating and health, and

that female respondents demonstrated that they had more control over

their eating habits than males.

More 38%

About the same 38%

Less 24%

43

Considering cultural backgrounds, as shown in Figure (18), we found

that only Africans ate ‘more’ mixtures of different kinds of food (56%)

than they used to in their home countries. While a high proportion (45%)

of people from MENA ate the ‘same’ mixture of different kinds of food

they used to in their home countries, people from Asia divided equally

between the three options.

4.3 Access to health services

To assess the respondents’ ability to access health services, two main

questions were posed, followed by three follow up questions to find more

detailed information. The main questions asked whether respondents

were registered with a family doctor (General Practitioner or GP) and a

dentist. Below we will explore the findings.

4.3.1 Are you registered with a doctor?

The first question was answered by all the respondents, and 21 percent

of them had not registered with a GP.

0

10

20

30

40

50

60

Female Male

Figure (17): Mixture of Different Food by Gender

More

About the same

Less

0

10

20

30

40

50

60

Aferica MENA Asia

Figure (18): Mixture of Different Food by Region

More About the same Less

44

Figure (19): Are you registered with a doctor?

Of those who had registered at a GP, 49 percent had managed to do it in

less than a month, 42 percent within three months and the rest after

more than six months. The last group cited ‘lack of information’ as their

reason for taking so long time.

Those who had not registered at a GP at the time of the interview cited

different reasons, such as: ‘my health is good’, ‘ I am fit’, ‘I am not

educated so I could not understand’, ‘I am still in the asylum process’, ‘I

didn’t receive any paper about it’, ‘I don’t know where GP could be

found’. These reasons could be summed up in one reason: ‘lack of

knowledge’.

4.3.2 Are you registered with a dentist?

98 of the respondents answered the second question: Are you registered

with a dentist? As shown in Figure (20) 37 percent were not registered

with a dentist at the time of the interview.

Figure (20): Are registered with a dentist?

Yes 79%

No 21%

Yes 63%

No 37%

45

Of those who had registered with a dentist, 39 percent took less than a

month to register, 45 percent between one and three months, five

percent three to six months, and three percent more than six months.

Those who took more than three months to get a dentist gave reasons

such as: not needed, didn’t know how, a long waiting process, shortage

of time, don’t like dentistry, still in the asylum process, have no problem

with my teeth, I don’t know how and where to go a dentist, I don’t like

doctors, I lost an appointment, I need very much to go to dentist, but I

don’t know how, waiting for GP, paper.

This study shows that lack of knowledge of the way the health system

operates is the main reason for delaying registration with a GP or a

dentist. Many people have come from countries where access to health

services is different from the system in the UK. Despite the fact that

some organisations provide written information on how to access the

health services, a considerable number could not access the services at

suitable times due to their lack of information / knowledge. Therefore,

we argue that it would be useful either to review or to change the method

by which the information is provided.

4.3.3 How has your health been since you have come to UK?

The third question addressed to the respondents concerned their

subjective feelings about their health since their arrival in the UK

compared to what they experienced in their home countries. 41 percent

of the respondents said their health had improved since their arrival in

the UK, while 22 percent felt the opposite.

46

Figure (21): How has your health been compared to in your country?

Two types of examples of the statements made by respondents follow:-

From respondents who felt better:

Back home I used to suffer from depression and had no money to

pay for my treatment,

Because I am very happy, and I don`t have problem of killing,

punishment and capital punishment.

So I feel freedom, because in the U.K I have more freedom, but in

Iran I have not any freedom, and I don`t have any problem like my

country in social life and political,

Because l do some exercises,

Because I feel safe, eating is better.

The air is better and the life is more comfortable,

Warm people in Glasgow, and

Fewer problems, good freedom and the human equality in this

country.

From respondents who felt worse:

stressed about my on-going immigration case, which had taken too

long, Bad weather and housing,

because for being foreign and stressed,

Because I miss my family and I have problem with different culture

and language.

Also I have problem with my case,

Better 41%

Same 37%

Worse 22%

47

Because still I did not get a paper so it is affecting me and affects

my mental health,

During my journey I was faced the more health problem then in

there I have many problem with my case. So that my mental

situation was changed to bad,

I am very worried and I have mental problem,

I have not work, and I miss my family,

I find it very difficult to cope with the weather and also, No sunshine

and too dark,

So much stress, spending most of the time at home without doing

anything that effected lot on my health, and

Suffering depression because still not got papers.

4.4 Activities

In order to assess the respondents’ needs, that would improve their

wellbeing in Glasgow, various training activities were listed and the

respondents were asked to choose which one(s) people might be

expected to attend. Each respondent could select more than one

activity. Figure (22) summarises the answers.

For example, 88 percent said that people could be expected to attend

workshops related to mental wellbeing (54% stress management

activities and 34% mental health); this is a good indicator of the stress

and mental health of the newcomers.

In addition to what the refugees and asylum seekers experienced in their

home country, and the process of fleeing the situation there, they also

suffer a lot during the process of establishing their lives in UK. 81 per

cent would like to improve their access to the labour market (48 percent

employment, and 33 percent for business establishment), 78 percent

want to improve their health by doing exercises (44 per cent), and/ or by

healthy eating and cooking (34 per cent) .

48

Figure (22): Do you think people are interested in attending workshops on..

Dedicated:

Olivia

volunteering,

even with a

broken ankle!

0 10 20 30 40 50 60

Relation

Exercise

Diseases and illness

Healthy eating and cooking

Age

Women health

Men health

Mental health

Child health

Youth

Safety

Alcohol or drugs

Smoking

Stress management

Outdoors

Indoor

Money management

Glasgow places

Customs and culture

Employment

Business

Education

Housing

49

Chapter Five: Organisation survey results

5.1 Aims and Objectives

The main aims and objectives of this part of the research project were to:

Ask organisations what type of support they currently provide for

refugees and asylum seekers.

Find out what organisations think new refugees and asylum

seekers need in order to live healthily in Glasgow

Find out what organisations think are the best ways of presenting

information to people who do not have English as their first

language.

Sample

Twenty organisations which work closely with refugees and are based in

Glasgow were approached and asked to participate in the survey. It was

thought they could provide additional information and insights.

5.2 Findings

Question 1.

Background Information

Please see spread sheet of organisations and the contact person there

(Appendix Four).

Question 2.

What support does your organisation provide to refugees and

asylum seekers?

Please see spread sheet for responses (Appendix Five).

50

Question 3.

Please tell me about your role in the organisation.

The roles were all individual – they are briefly summarised on the spread

sheet for Question 1 (Appendix Four) and listed here for information.

I am the Project Coordinator and am responsible for the day-to-day

running of the organisation and service delivery (Unity Centre).

I am a religious sister, l am also a local superior; I live a simple life

as any poor person would live (Missionaries of Charity).

I am manager of the Scotland Centre. I work strategically across 5

locations of the organisation. I am also a therapist and work with

individuals (Freedom from Torture).

I signpost and pass on information. I run and organise the group. I

listen to people's stories, help them with any problems I can, help

them build relationships and share their experiences as single

mothers. I help them build their confidence and independence

(Umoja).

I am the Female Outreach Worker. I work with awareness raising

over HIV testing, condom use and condom distribution. To provide

information about access to information to these issues. I am

involved in running workshops. I also signpost to other

organisations who can help with their needs should issues like

housing arise (Waverley Care).

Provision of emotional support, advice and information on services

available to asylum and refugee women (Ethnic Minorities Law

Centre).

I am one of the founding members of the organisation and ex-chair

person and acting chair for around three years. Due to this I assist

the current management when I am required to and contribute

towards the improvement of the organisation’s functions. I do also

address some queries from other organisations and funders who

use to contact me every now and then and signpost them

accordingly (Ypeople Residents’ Association).

The Health Service: 1. knows and understands the inequalities &

discrimination faced by its patients and population; 2. engages

with those experiencing inequality & discrimination; 3. knows that

people’s experience of inequality affects the health choices they

make; 4. removes obstacles to services and health information

51

caused by inequality; 5. uses an understanding of inequality and

discrimination when devising treatment and care; 6. uses its core

budget and staff resources differently to tackle inequality (NHS).

My role is development of people and projects in Glasgow

Edinburgh, Stirling, Fife, Newcastle and Inverness (Destiny

Angels).

A member of the Management Committee: at one time I was chair

of the organisation (Karibu Scotland).

I help run the drop-in and support volunteers and work with the

community flat (G&CIN).

I help run all the above activities as a volunteer support worker

(Ycommunity).

I manage housing advice and the destitution project. There are 2

teams. One provides housing advice, the other money skills

advice and runs the drop-in (Positive Action in Housing).

Office Manager (Bridges Programmes).

I am the campaign coordinator (NCADC).

Development worker, general manager (Unity in Community).

Life Skill Programme Manager (British Red Cross Refugee

Service).

Women`s policy development officer (Scottish Refugee Council).

Question 4.

What field does your organisation provide support in?

See spread sheet for a tabular summary of the different fields of support

(Appendix Five)

The support was mostly in providing general information (15

organisations) and training (11).

Many organisations offer general advice (9), clothing (9), employability

help (8) and food (8).

Less common are organisations that offer immigration information (4),

legal support (3), money (3), stress management (3) and

accommodation (3).

52

Support was provided for cultural issues by 7 organisations and issues of

violence (5), minority ethnic issues (6) and mental health support (6).

Question 5.

How do you provide that support?

Some organisations provide a drop-in service: Ycommunity, Unity

Women’s Project, GCIN, Karibu and Destiny Angels.

Destiny Angels also run a helpline and mobile food banks.

Freedom from Torture provides therapy, which is open-ended. Clients

have to be referred.

Emotional support is also provided by Umoja and Waverley Care.

Waverley Care also direct people to relevant organisations for their

needs.

Ypeople runs a weekly surgery to have first-hand knowledge of the

problems and needs of the residents and liaise with the appropriate

department.

Positive Action in Housing and Unity also sign post people to other

organisations.

Karibu, Destiny Angels and EMLC run one to one support sessions.

Bridges Programme and NCADC provide training.

Question 6.

What do you think people need to live a healthy life?

Fifteen respondents answered this question.

Most respondents (12) stated that people need healthy food/a healthy

diet in order to live a healthy life.

53

Five respondents replied that (a) information about healthy living was

important and (b) information about exercise and sport was important.

Three respondents named housing/shelter, medical services/healthcare,

community support and social activities and good mental health as

important factors.

Two respondents named hope or having a meaning in life as important.

Safety and security, money, and advice about entitlements were

considered necessary by one respondent.

Question 7.

What do you think refugees and asylum seekers need to know to

live healthily in Glasgow?

The responses of organisations to this question can be divided into

seven sections.

Section 1: Food

Where to get cheap, healthy food

Awareness of what is healthy and unhealthy food

Cookery lessons/demonstrations

Section 2: Exercise

Where to go for free/cheap exercise e.g. parks, exercise groups,

football groups

Section 3: Healthcare

How the NHS and the GP system work

Reproductive health

Children’s health

Section 4: Mental health

Assistance in dealing with past trauma

Assistance in dealing with present and future uncertainty

54

Orientation to work through and accept cultural and life style

differences

Section 5: Financial

Help with travel costs

How to survive on very little money

Budgeting advice

Section 6: Networking

Access to community activities

Informal support structures

Help to integrate

More English classes

Information about drop-ins

Information about women’s groups

Section 7: Rights

Knowledge of rights and entitlements regarding asylum

Knowledge of benefits/rights to work

How organisations are structured

Question 8.

From your experience do you have any suggestions about how

health information can be shared with people whose first language

is not English?

There were a variety of responses to this question, with some

disagreement about the most effective approaches. All respondents

except one answered this question (19 out of 20).

The most popular solutions to sharing health information with people

whose first language is not English were (a) using multi-media

methods (9 respondents) and (b) using people-oriented events (9

respondents).

(a) Visual and audio methods were recommended as effective ways of

presenting health issues; for example, picture cards, photographs,

videos, posters, documentaries.

55

(b) The importance of people-centred events for passing on

information was also highlighted e.g. having a mixture of one-to-

one sessions and group discussions, demonstrations or

workshops; involving key people from the community; having a

system of befriending/mentoring in the community.

Examples given were of one-to-one help with using the internet and groups for cookery classes and First Aid.

Two respondents recommended offering women-only groups: one to explore issues such as sexual and domestic violence and the other to provide an opportunity to speak to an expert e.g. a midwife about women’s specific health issues.

Several respondents recommended using interpreters (8 respondents) although one respondent disagreed and warned that using an interpreter can ‘skew the relationships and the transfer of knowledge.’ However another respondent stated that ‘the only way is to have translators’.

Another suggestion was translating leaflets into different languages (5 respondents). One respondent suggested providing information leaflets at drop-in centres used by asylum seekers and another suggestion was to provide information in packs when people first arrive from their induction. However, two respondents did not consider this effective due to literacy issues, expense and the difficulty of keeping information up to date. It was suggested that having material available on-line would be cheaper. Other suggestions were to make recipe books combining recipes from different countries, and to use sporting activities as a way of getting people together and sharing information. Question 9. Do you know any organisations or groups who could provide

Healthy Living workshops for us?

There were many suggestions of suitable organisations and groups:

Wise Women: http://www.wisewomen.org.uk/

Sure Start:

http://www.direct.gov.uk/en/Parents/Preschooldevelopmentandlearnin

g/NurseriesPlaygroupsReceptionClasses/DG_173054

56

North West Women's Centre:

http://www.maryhillwomenscentreglasgow.org.uk/

Karibu Scotland:

http://www.karibuscotland.org.uk

Lifelink: http://www.lifelink.org.uk/

Nutritionists from the NHS

We (Freedom from Torture) can do psycho-educational programs.

We look specifically at post-traumatic symptoms. In groups people

can get help and advice and it doesn't have to be personal.

Unity Centre

Scottish Refugee Council

Refugee Women’s Strategy Group (RWSG)

We (Waverley) provide sexual health workshops but we focus on HIV.

Asda Community Events: http://your.asda.com/community

Health and Well-being centre in Kingsway; there is also a centre in a

Royston.

Govan and Craigton Integration Network developed a book which

included healthy recipes from all different countries.

NHS also had a project last year where they gave information.

EMLC Leisure classes for women

Ethnic Enable- befriending and Workshops: www.ethnicenable.org.uk

Glasgow women's library-courses and workshops:

http://womenslibrary.org.uk/

Bridging the Gap:

http://www.educationscotland.gov.uk/Images/Bridging_The_Gap_tcm

4-552837.pdf

Ankur -0141 248 8889 - workshops

Food for Thought - healthy eating and cooking- not free

Simple Pleasures - access to green space – free:

http://www.snh.gov.uk/enjoying-the-outdoors/simple-pleasures/

BTCV: Conservation volunteering

http://www2.tcv.org.uk/display/btcv_scotland

Glasgow Life -taster session for all of their services:

http://www.glasgowlife.org.uk/Pages/default.aspx

Compass- mental health awareness sessions ( capacity issues):

http://www.nhsggc.org.uk/content/default.asp?page=home_compass

Health Team (Dr Anne Douglas).

57

integration networks and YMCA

Hidden Gardens , Red Cross,

Freedom from Torture

Work Glasgow Community Food Interactive:

http://www.communityfoodandhealth.org.uk/

Work Glasgow Healthy Living Community:

http://www.healthynorthglasgow.co.uk/nghlc/work-areas

Question 10.

Do you know any asylum seekers or refugees who may have skills

or information about healthy living?

Most respondents did not know anyone with appropriate skills or

information about healthy living.

Other respondents suggested that the following agencies could help:

Barnardos has a group that works with refugees over HIV

Waverley Care

Scottish Refugee Council (SRC)

British Red Cross

Refugee Women’s Strategy Group (RWSG)

Question 11.

Do you have any other comments you would like to make about

healthy living in Glasgow?

Comments from the organisations centred around the difficulties of

accessing information:

Life Skill Programme only works with the most vulnerable young

people (30 each year) with information about healthy living: [it is]

also valuable for the vast majority of young asylum seekers that we

do not have capacity to support e.g. information on access to

sexual /mental health services and support to access education.

I do think there is a gap in information and services provided.

58

I think that it is worthwhile explaining this. It would be effective if

the balance between what people knew and needed to have the

confidence to do things themselves could be bridged. Walking,

being taken to different clinics and services to show people would

help. Being encouraged to role play and dialogue with other

mental professionals would help. People are often too

embarrassed to say if they don't understand (Umoja).

You can't force people to change but you can give them the

information to help themselves. There can be great benefits to

awareness raising. I would like to be invited to any workshops and

events (Waverley Care).

Need to encourage/ educate asylum seekers and refuges about

the benefit of physical activity to health e.g. walks, running,

swimming etc.

Other comments dealt with the political aspects of support:

Many of the women we support have major difficulties accessing

basic and specialist services because of their vulnerabilities and

the discrimination they experience. This coupled with the stress of

an ongoing asylum case creates huge barriers to women asylum

seekers having healthy lifestyles (Unity).

Are you going to use any information featured from your sessions

to explain to politicians how hard it is to live a healthy life when you

are under the stress, both financial and emotional of going through

the asylum process?

I think it is a good idea, if there is some focussed work in this area,

it will have an impact on the mental health of asylum seekers.

Especially for destitute people as they need advice on how they

can buy and prepare food healthily on limited budget and not eat

things like fish and chips all the time

Living in real poverty, sometimes with no money at all, is a big

issue. As is living under threat of detention/deportation/removal.

59

Stress. Losing your GP when refused asylum and having to move

and became homeless.

The biggest health effect for asylum seekers in Glasgow would be

to give them their papers.

Sharing food after one of the Healthy Eating & Cooking Workshops

(This one delivered by Soghra from Woodlands Community Garden)

60

Chapter 6: Conclusions

This study is pioneering action research carried out by Living Well in

Glasgow with the support of Community InfoSource. The research was

a baseline study which aimed to provide information needed to develop

activities for the refugees in order to improve their living standard, health

and wellbeing in Glasgow. The research was designed and

implemented by refugees. They used mainly quantitative and some

qualitative research methods to collect the data, the bulk of which was

analysed by SPSS statistical software.

Respondents were 100 refugees from Africa, Middle East and North

Africa (MENA) and South and East Asia. In addition supplementary data

was collected from 20 key informants from organisations that provide

services to the target group. Questions addressed to the refugees were

clustered into three groups: access to healthy food and change in their

food intake; access to health services and change in their health status;

and their subjective gap of knowledge that prevented them from having

good health and wellbeing in Glasgow.

The first part of the individual surveys explored cooking skills and access

to nutritious food. It became clear that almost one third of interviewees

needed to improve their cooking skills and to have their awareness

raised of healthy eating. The group in most need of these were males

from MENA.

We also explored the extent to which people had changed the food that

they ate, and if they continued to eat healthily with an appropriate intake

of fruit and vegetables. Results appeared rather complex and

contradictory and there were no clear trends. Where changes had taken

place, sometimes this seemed to lead to improvements in diet and

sometimes the opposite. Improvements were attributed to security,

better standards of living and better access to health services, while

those whose diet had not improved spoke of the stress they had felt

during the asylum and settlement process, together with feelings of

longing and loneliness. They stated that they used to eat better in their

home country.

61

Regarding access to services, the majority of interviewees were

registered with a GP and a dentist, but a significant minority were not

registered and, in some cases, there had been a considerable delay in

registering. The most cited reason for this was a lack of information.

There was a relatively even split between those interviewees who felt

that their health had improved since coming to the UK and those whose

health remained the same. In 22% of cases, their health was felt to be

worse. Those who felt better attributed this to freedom from persecution

and threat, to safety and a more comfortable existence. Those who felt

worse highlighted the stress of getting used to a different culture and

language, as well as being separated from family.

Finally, in relation to activities, it was clear that interviewees were keen to

improve their employability and access to the labour market, and were

also concerned to improve their health. This could be achieved by

exercise and leisure activity as well as by healthy eating and cooking.

The organisations interviewed offered a wide range of support – both

emotional and practical. Some offered advice sessions and had drop-in

services; others had ‘helplines’. Practical support included advice on

housing and employment, training mobile food banks.

All organisations stressed the importance of healthy eating, of exercise

and sport, and of safety and security in helping refugees to ‘live well’.

This echoes many of the findings of other studies elsewhere and which

are described in Chapter Two. There was general agreement that

refugees needed to know about food, exercise and sport, healthcare

provision and the availability of community activities. In addition, for

long-term safety and security, refugees need information on their rights

and entitlements, and financial advice.

In terms of advising refugees on these matters, organisations suggested

a wide range of methods, including the use of visual and audio material,

for those needing support with English language, and group sessions,

possibly with interpreters. These suggestions echo some of the refugee

toolkits developed by outreach workers in America and Australia, and

described in Chapter Two.

62

Recommendations

In accordance with the Scottish Government’s strategy paper of 2013:

“New Scots: Integrating Refugees in Scotland’s Communities 2014 to

2017”, we make the following 10 recommendations:

Partnership working should be arranged to support the

development of workshops on all key topics requested by refugees

Refugees must be involved as key partners in any new workshops

being developed

Putting funding in place to provide more mental wellbeing

workshops as developed by Living Well in Glasgow, these being

the highest priority identified in the research. Current provision in

Glasgow is extremely stretched and tends to only reach those who

are in an emergency situation

Putting funding in place to provide additional employability support

Dissemination of good practice and audio-visual learning methods

of delivering information for refugees

Investment in development of multi media types of information

provision and person centred events for refugees

Provision of a ‘Training for Trainers’ specialised package to support

good practice in delivering information to refugees

Provision of information in improved and accessible formats for

newly arrived asylum seekers

Provision of orientation support for new asylum seekers to learn

about Glasgow and the types and locations of services in it

Provision of culturally sensitive and inexpensive physical activities

in the city

63

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66

Appendices

Appendix One Timeline

January 2011

Ypeople Glasgow Residents’ Association (now Scottish Asylum Seekers

Residents’ Association [SASRA]) and Community InfoSource CIC (CIS)

agree to develop the Living Well in Glasgow project

April 2011

Formal agreement in place between YGRA and CIS

1st Planning Group Meeting of Living Well in Glasgow (LWiG) takes

place, agree to meet monthly

Application made to Voluntary Action Fund’s European Year of the

Volunteer grant for the Administration side of the project in the

office

May 2011

Grant application made to Scottish Community Foundation for the

Research Project

June 2011

A Volunteer Co-ordinator takes up the voluntary position and we start

working towards Volunteer Friendly Accreditation

August 2011

Grants awarded for the two projects:

o £995 from European Year of the Volunteer grant (Voluntary

Action Fund)

o £1,966 from the Hilden Charitable Trust and RND Community

Cash Fund (through Scottish Community Foundation, now

Foundation Scotland)

Volunteer Policy agreed by the Planning Group

September 2011

Planning Group agrees recruitment information and dates for

volunteers for both projects

67

Advertising takes place for the volunteer positions

Shortlisting and interviewing takes place for both projects and

volunteers are recruited

October 2011

Introductory meeting for all volunteers takes place

Administration volunteers start working in YGRA and CIS’s office

Research volunteers start training in Ycommunity in Springburn

Steering Group Meeting 1 takes place with advisers to the project

November 2011

A survey is developed by the researchers and piloting starts

Financial accounting spreadsheets are set up by the Administration

volunteers

December 2011

A corporate image starts to be developed

The pilot survey takes in 50 respondents and the analysis starts

using Survey Monkey

A Christmas night out takes place at the CCA with food and a

poetry night

January 2012

The Survey Monkey analysis method is completed and the 50

surveys are input

The main survey is developed and individuals start to be

interviewed

A separate survey is developed for organisations

February 2012

The main Survey Monkey method of analysis is finalised and

surveys start to be input

Interviews start with organisations and individual surveys continue

Volunteers have a general meeting & support & supervision

meetings are arranged

LWiG emails are functioning

68

The analysis of the pilot survey is completed and a report is

compiled

Method of analysing the organisations surveys is completed

Steering Group Meeting 2 takes place to hear about the pilot

survey and progress

March and April 2012

Interviews continue with organisations and analysis is ongoing

Individual surveys continue and analysis is ongoing

Logo and website developed and live

June 2012

Refugee Week event to launch the research and carry out two pilot

workshops for stress management

September 2012 to January 2013

Volunteers developed and submitted funding applications for

workshops based on survey & interview information.

Grants awarded for the two projects:

o £1,995 from Communities 2014 grant (Big Lottery Fund) for

Zumba classes

o £9,282 from Awards for All (Big Lottery Fund) for two sets of

workshops plus the launch of the research and analysis once

complete.

A new volunteer supports the project by analysing the information

gathered from organisations

March to September 2013

Planning Group agrees recruitment information and dates for

volunteers for the workshop development

Advertising takes place for the volunteer positions

Shortlisting and interviewing takes place and volunteers are

recruited

An additional volunteer is recruited to help with the analysis of the

research data from individuals

Volunteers start to develop the format and programme for

workshops, based on the research findings

69

Advice is sought from professionals with experience in our fields of

interest

Agreements are reached with support organisations for delivery of

parts of workshops

Advertising takes place to access participants

October 2013 to January 2014

Pilot workshops take place to help us decide what works best in practice:

1. Mental Wellbeing – separate sessions for men and women

2. Healthy Eating & Cooking – mixed sessions in the afternoons and

women only in the mornings

3. Zumba – exercise classes, women only and mixed

These workshops were all very well received and there has been great

demand from participants and other professionals, that they run again.

Celebration of current volunteers takes place followed by Christmas

meal. See the results: www.lwig.org.uk

February to April 2014

Research analysis completed and report written up

Report on Zumba workshops completed

Launch of research prepared for May 2014

Projects for future decided on and starting to be developed

Fundraising applications being prepared

Volunteer fundraisers urgently required!

April 2014

70

Appendix Two

Letter of Introduction and Individual Survey

Research project: Healthy Living Needs of Newcomers Who We Are Living Well in Glasgow is a partnership between Community InfoSource and Ypeople Glasgow Residents’ Association which is developing this project. The research Living Well in Glasgow is a Healthy Living Pilot project being developed to provide health and well being information for people who have come to live in Britain from a different culture. The research is being carried out by asylum seekers and refugees who have been trained for this project and who are volunteering. You will be asked about how you live now compared to before you came here and about what would have been helpful for you to know when you arrived. Your Role Without you, this research would not be possible – we need you to talk to us about the information you felt you needed to live in a healthy way when you came to stay in Glasgow. The interviews will be completely anonymous and you do not have to answer any question if you do not wish to do so. Each interview should last about half an hour. Thank you very much for your support and help

LWiG, C/o YGRA Mailbox, 33 Petershill Drive, Glasgow G21 4QQ;

YGRA phone: 0141 557 6112; CIS phone: 0141 946 6193; Email: lwig@communityinfosource.org.uk

Tear off here and return to researcher I have read the information sheet and understand the reasons for the research. I understand that any comments that I make will be kept anonymous. Name: Signed: Date:

71

Living Well in Glasgow

Living Well connecting people, improving lives

Introduction

Thank you for meeting me today. Check: are you still happy to be involved with the

research?

(Give participant LWiG sheet). Suggest they put it in a safe and/or prominent place e.g.

notice board, so they can see it easily if they need to contact LWiG at anytime).

Points to discuss with participant before they give Consent:

What we are going to discuss today is health and food. I am going to ask you some questions about healthy living and whether you feel your health or lifestyle has changed since you came to Glasgow. Also whether you would like to receive more information about health. The reason we are asking is that we want to set up some workshops where we can provide talks and information to new arrivals about health topics.

There are some personal questions such as about age or nationality but these are only for our records and won’t be shared. You do not have to answer anything you do not wish to share.

If there is anything you don’t want to talk about just say so. This interview is about me having the opportunity to understand what life is like for you and your family at this time - you are the expert, and I hope to be following your lead in what we talk about today. If however we do stray onto a subject that you don’t want to discuss now or at any other time during the research, then please don’t be afraid to tell me and we can talk about something else.

We can stop whenever you like. If you want to take a break, feel upset or unwell; please just let me know and we can finish the session.

You will not be named in anything I write about this research, it will be anonymous.

So that I can protect your identity I will ask for your name and contact details at the end but will only if you are interested in future events that we are planning.

Signing Consent Form

You have a sheet to give the participant, with a tear-off sheet on the end of it.

Make sure the participant is giving his / her consent to take part in the research.

Does this all sound okay? Would you like to ask me to explain anything, or do you have any

questions?

72

Begin interview

Living Well in Glasgow Research First stage No. ___

Circle or tick the correct answer

1. Food you are eating now, compared to before in your own country:

a. Are you eating the same foods? Yes / No

b. Do you mainly cook for yourself or do you buy more fast foods or take-away?

Mainly cook; Mainly buy fast food/take-away; Both

c. Are you eating the same mixture of different foods?

More of a mixture; About the same Less of a mixture

Less - why is that?

Too expensive; Not available; Takes too long to cook; No time; No

cooking skills; No appetite; Life style changes;

Other / what:

_____________________________________________________________________________________________

More - why is that?

Less expensive; More available; Easily available; More time; More

appetite; More money to buy; Life style changes;

Other / what:

_____________________________________________________________________________________________

d. Are you eating the same amount of fruit and vegetables?

More; About the same Less

Why is that (if different)?

______________________________________________________________

______________________________________________________________

e. Are you eating the same amount of food?

More; About the same Less

Why is that (if different)?

______________________________________________________________

______________________________________________________________

2. What country are you from?

________________________________________________________________

73

3. How long since you came to UK?

Under 1 month; Less than 6 months; Less than 1 year;

Less than 3 years; 3+ years

4. How long since you came to Glasgow?

Under 1 month; Less than 6 months; Less than 1 year;

Less than 3 years; 3+ years

5. What is your status?

Refugee; asylum seeker; asylum seeker on section 4 support;

asylum seeker on no support (destitute); other ________________

6. Are you registered with a doctor? Yes / No

a. Yes: how long did it take you?

Under 1 month; 1 - 3 months; 4 – 6 months; Over 6 months

If over 3 months: why did it take so long?

________________________________________________________

b. No: why is that?

______________________________________________________________

7. Are you registered with a dentist? Yes / No

a. Yes: how long did it take you?

Under 1 month; 1 - 3 months; 4 – 6 months; Over 6 months

If over 3 months: why did it take so long?

______________________________________________________________

b. No: why is that

8. Since you arrived in Glasgow, how has your health been?

a. How has your health been, compared to in your country?

Better Same Worse

b. Why do you think that is (only if better or worse)?

______________________________________________________________

______________________________________________________________

74

9. Do you think people would be interested to attend special events or

workshops on the following issue

Other: _________________________________________________________

______________________________________________________________

10. Is there anything you would like to know about health?

__________________________________________________________

__________________________________________________________

11. What would you need to be able to attend a workshop?

a. Would you need childcare?

Childcare: how many would need it? _____________________________

What ages of children? ______________________________________

b. What gender are you?

Female Male Other

c. Would you like separate times for men and women?

Yes / No

d. What would be the best time of day for you?

10am – 2pm; 12 noon – 4pm; 2pm to 6pm; 4pm – 8pm

e. What would be the best day of the week?

Monday; Tuesday; Wednesday; Thursday; Friday; Saturday; Sunday; Any

If Saturday or Sunday, which times?

10am – 2pm; 12 noon – 4pm; 2pm to 6pm;

f. Interpreter?

Yes / No If yes, what languages?

_________________________________________________

a. Relationships b. Women’s health

c. Smoking d. Employment

e. Activities & exercise f. Men’s health g. Stress management

h. Business

i. Diseases & illnesses j. Mental health k. Outdoors l. Education m. Healthy eating /

cooking n. Children’s

health o. Indoors p. Housing

q. Parenting r. Youth s. Money management

t. Special needs u. Safety v. Glasgow places w. 50 + x. Alcohol or

drugs y. Customs &

culture

75

g. In which area of Glasgow would you like workshops to be held?

______________________________________________________

h. Would you have any personal difficulties or support needs to be able to attend

a workshop?

Yes / No If yes, what?

___________________________________________________________

i. Transport expenses?

Yes / No

j. What age are you?

Under 18; 18-24; 25-34; 35-59; 60+

12. How can health information be presented to people whose first language is

not English?

__________________________________________________________

13. Do you, or anyone you know, who is an asylum seeker or refugee have

skills or information about healthy living, to share?

Could you ask them to contact us? Or tell us their name?

_________________________________________________________

14. How did you find this discussion?

Interesting; useful; hard to understand the questions; good

Other? ____________________________________________________

15. Any other comment you would like to make?

___________________________________________________________

16. When the Living Well project is starting, would you like us to invite you to

it? If yes:

Name: ________________________________________________________

Address: ______________________________________________________

Phone: ________________________________________________________

Email: _________________________________________________________

17. Could we talk to you again when we have developed the plans more?

Yes / Maybe / No / Don’t know

Name of researcher:

Date of interview:

Researcher comments:

76

Appendix Three

Letter of introduction and organisational survey

Research project: Healthy Living Needs of Newcomers

Who We Are Living Well in Glasgow is a partnership between Community InfoSource and Ypeople Glasgow Residents’ Association which is developing this project. The research Living Well in Glasgow is a Healthy Living Pilot project being developed to provide health and well being information for people who have come to live in Glasgow from a different background. The research is being carried out by asylum seekers and refugees who have been trained for this project and who are volunteering. Your Role We would like you to talk to us about the information you feel refugees and asylum seekers who are new to Glasgow need to know to live in a healthy way, especially when they have come from a different climatic or cultural background. Also how you think that information should be presented. Thank you very much for your support and help

LWiG, C/o YGRA Mailbox, 33 Petershill Drive, Glasgow G21 4QQ;

YGRA phone: 0141 557 6112; CIS phone: 0141 946 6193; Email: info@lwig.org.uk

Tear off here and return to researcher

I have read the information sheet and understand the reasons for the research.

Name:

Signed: Date:

77

Living Well in Glasgow

Living Well connecting people, improving lives

Introduction First Stage Research for Organisations

Thank you for meeting me today. Check: are you still happy to be involved with this

research? (Give participant LWiG details).

Points to discuss with participant from an organisation:

What we are going to discuss today is what you think new refugees and asylum

seekers need to know to live healthily in Glasgow

We will also ask about methods of presenting information to people who do not

have English as their first language

You do not have to answer anything you do not wish to.

We would like to quote you in our research report. If there are certain things you

say that you would rather NOT be quoted then please just tell me.

Let me reassure you, if you wish we can offer you pseudo-anonymity. This is

when your name is changed in any reports or publications so no one can

recognise you. You can even pick the name you wish to be called in our report!

Signing Consent Form

You have a sheet to give the participant, with a tear-off sheet on the end of it.

Ask the participant to give his / her consent to take part in the research.

Does this all sound okay? Would you like to ask me to explain anything, or do you

have any questions?

Begin interview

Living Well in Glasgow Research Organisation No. ___

Organisation’s full name:

__________________________________________________

Your name and position:

___________________________________________________

Organisation’s Email address:

_____________________________________________

Organisation’s Phone number:

_____________________________________________

78

1. What support does your organisation provide to refugees and asylum

seekers?

_____________________________________________________________

______________________________________________________________

1a) Please tell me about your role in the organisation:

_____________________________________________________________

______________________________________________________________

Circle or tick the correct answer

2. What field does your organisation provide support in?

a. Medical treatment

b. Information general

c. Advice general

d. Legal

e. Money

f. Food

g. Clothing

h. Training

i. Mental heath

j. Stress

k. Education

l. Employability skills

m. Accommodation

n. Immigration

o. Minority ethnic issues

p. Violence

q. Cultural

Other / what: _______________________

2a) How do you provide that support?

_____________________________________________________________

______________________________________________________________

2b) What do you think people need to live a healthy life?

______________________________________________________________

______________________________________________________________

79

3. What do you think refugees and asylum seekers need to know to live

healthily in Glasgow?

______________________________________________________________

______________________________________________________________

4. From your experience, do you have any suggestions about how health

information can be shared with people whose first language is not English?

______________________________________________________________

______________________________________________________________

5. Do you know any organisations or groups who could provide Healthy

Living workshops for us?

______________________________________________________________

______________________________________________________________

6. Do you know any asylum seekers or refugees who may have skills or

information about healthy living, to share?

Could you tell us their name? Or ask them to contact us?

______________________________________________________________

______________________________________________________________

7. Do you have any other comments you would like to make about

healthy living in Glasgow?

______________________________________________________________

8. Do you wish a copy of our research findings?

Yes No

Name of researcher:

Date of interview:

Researcher comments:

Time interview took to conduct?

80

Appendix Four

Organisations Surveyed

Name of Organisation Name of Contact and Position North Glasgow Integration Network Donald Lawrie

Development Worker

Scottish Refugee Council Nina Murray Women`s Policy Development Officer

British Red Cross Refugee Service Megan Rothnie Life Skills Programme Manager

Unity Centre Phill Jones Development Worker General Manager

National Coalition of Anti Deportation Campaigns

Michael Collins Campaign Coordinator

Bridges Programme Fiona Colbron-Brown Office Manager

Positive Action in Housing Sraboni Bhattacharya Project Manager

Ycommunity Bechaela Walker Volunteer support worker

Govan & Craigton Information Network Emma Zetterström Project development worker

Karibu Scotland Twimukye Mushaka Management commitee

Destiny Angels Susan Coupland

NHS Greater Glasgow & Clyde Nuzhat Mirza Corporate Inequalities Practioners

Ypeople Glasgow Residents' Association Hassan Darasi Member

Ethnic Minorities Law Centre L. Zibi Female Support Worker

Waverley Care (African Health Project) Margaret Lance Nat. Outreach & Developm'n tWorker

Glasgow Refugee, Asylum & Migration Network

Alan White Postgraduate Researcher/Intern

Umoja Inc Vicky Grandon Saturday Group Organiser

Freedom From Torture Scotland Norma McKinnon

Missionaries of Charity Sr. H Vianita H.C Superior

The Unity Women's Project Jane Pennington Project Coordinator

81

Appendix Five

Support Provided by Organisations Surveyed

Name General Information

General Advice

Legal Money Food Clothing Training

Mental Health

North Glasgow Integration Network Yes Yes - - Yes Yes Yes Yes

Scottish Refugee Council Yes Yes Yes Yes - - Yes Yes

British Red Cross Refugee Service Yes Yes Yes - Yes - -

Unity Centre Yes Yes - - Yes Yes - -

National Coalition of Anti Deportation Campaigns Yes Yes - - - - Yes -

Bridges Programmes Yes - - - - Yes -

Positive action in Housing Yes Yes - Yes Yes Yes Yes Yes

Ycommunity Yes - - Yes Yes (planned) -

Govan & Craigton Information network Yes Yes - - Yes Yes Yes -

Karibu Scotland Yes Yes - - Yes Yes Yes -

Destiny Angels Yes - - - Yes Yes Yes -

NHS Greater Glasgow & Clyde Yes - - - - - Yes Yes

Ypeople Glasgow Residents' Association - - -

- - - - -

Ethnic Minorities Law Centre - - Yes - - - - -

Waverley Care (African Health Project) Yes Yes - - - - - -

Glasgow Refugee, Asylum and Migration Network Yes - -

- - - Yes -

Umoja Inc - - - - - - -

Freedom From Torture Scotland - - - - - - - Yes

Missionaries of Charity - - - - Yes Yes - -

The Unity Women's Project Yes Yes - - - - - Yes

Totals 15 9 3 3 8 9 11 6

82

Name Stress

Education

Employ-ability

Accomm-odation

Immigration

Minority Ethnic Issues

Violence

Cultural

North Glasgow Integration Network Yes Yes Yes - - Yes Yes Yes

Scottish Refugee Council Yes Yes Yes Yes Yes Yes Yes Yes

British Red Cross Refugee Service - Yes Yes - - - - Yes

Unity Centre - - - - - - - -

National Coalition of Anti Deportation Campaigns - - - - Yes - - -

Bridges Programmes - - Yes - - - - -

Positive action in Housing - - - Yes - - Yes Yes

Ycommunity - Yes - - - - - -

Govan & Craigton Information network - - Yes - - - - -

Karibu Scotland - - Yes - - - Yes Yes

Destiny Angels - - Yes - - - - -

NHS Greater Glasgow & Clyde - - Yes - - Yes - Yes

Ypeople Glasgow Residents' Association - - - Yes - - - -

Ethnic Minorities Law Centre - - - - Yes Yes - -

Waverley Care (African Health Project) - Yes - - - - - -

Glasgow Refugee, Asylum and Migration Network - Yes - - - - - -

Umoja Inc - - - - - Yes (?) - Yes (?)

Freedom From Torture Scotland - - - - - - - -

Missionaries of Charity - - - - - - - -

The Unity Women's Project Yes - - - Yes Yes Yes -

Totals 3 6 8 3 4 6 5 7

83

Name Other Comments

North Glasgow Integration Network

Scottish Refugee Council

British Red Cross Refugee Service

Unity Centre Volunteering opportunities

National Coalition of Anti Deportation Campaigns Anti-deportation support

Bridges Programmes

Positive action in Housing

Ycommunity

Govan & Craigton Information network

Karibu Scotland

Destiny Angels Furniture

NHS Greater Glasgow & Clyde Marginalised people

Ypeople Glasgow Residents' Association

Ethnic Minorities Law Centre

Waverley Care (African Health Project)

Glasgow Refugee, Asylum and Migration Network

Umoja Inc None of these are really applicable

Freedom From Torture Scotland Have a relief fund for people with problems. People are referred to us when they are in psychological treatment

Missionaries of Charity

The Unity Women's Project Violence against women including sexual and domestic violence, trafficking and torture

84

Voluntary Action Fund Administration Volunteers Mental Wellbeing Workshops

Healthy Eating & Cooking Workshops

Research Launch

Research funding

Communities 2014 Zumba workshops

www.lwig.org.uk

Community InfoSource • Company No SC291462 272 Bath Street • Glasgow • G2 4JR • Tel: 0141 946 6111

Email: info@communityinfosource.org.uk

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